Evaluating Listening Behaviours of Nightclub Goers: An International Web-Based Study with Resident Advisor

Abstract

Background:

Nightclubs expose nearly 40% of young adults in high- and middle-income countries to damaging levels of noise with attendant risk of noise-damage hearing symptoms and sequelae of mood disorders, social isolation and dementia. This study evaluated clubbers hearing symptoms, visiting behaviours and safe listening habits.

Material and Methods:

A web-based, population-specific data collection tool was shown to visitors of the dance music website Resident Advisor over a 7-hour period. It identified how often and for how long clubbers attend loud music venues (as this will influence their safe-noise dose) alongside their attitudes, use of safer listening practices and whether their visit frequency changed with the presence of hearing symptoms. For analysis, we used descriptive statistics, Chi-squared test, Fisher exact test and logistic regression analysis.

Results:

We collected 1020 (29.0%) responses from 3516 data collection tool invites. Key findings are as follows: 73.4% (n = 749) of respondents had permanent ear symptoms (‘sometimes’, ‘often’ or ‘always’). Respondents attended loud music venues 1–5 times per month (78.5%, n = 801) for a duration of 5–6 hours a visit (41.1%, n = 419) on average. When in loud venues, 32.3% wore earplugs, 38.5% took regular listening breaks, 5.9% checked the noise level, 45.4% moved to a quieter spot and 13.2% had a hearing test in the last year. Two-thirds and one-half of those with no or temporary hearing symptoms, respectively, would attend music venues less often if they were to develop symptoms or if symptoms were to worsen.

Conclusions:

Based on our visit data, the average music venue patron has some degree of permanent hearing-damage symptoms and should be aware that they are very likely to exceed their safe-noise dose (and risk irreversible hearing damage) even in venues adhering to the World Health Organization standard for safe listening loudness.

KEY MESSAGES:

• (1)Our visit data spotlight that the average clubber far exceeds their noise dose, even in venues adhering to the WHO ‘safe’ sound level of 100 dB LAeq, 15 min.
• (2)Safer listening practices, including earplugs, are therefore always required, but poorly utilised in our population of clubbers.
• (3)We found that the development of noise-induced hearing damage in music venue patrons will result in less-frequent attendance of clubbers at music events. Therefore, this is important for music industry stakeholders and policy-makers.

INTRODUCTION

Estimates suggest nearly 40% of teenagers and young adults in middle- and high-income countries are exposed to potentially damaging levels of noise in nightclubs.[1] A nightclub is one of the loudest leisure activities with estimates between 98 and 112 dBA.[2] Damage to hearing carries a symptom burden (e.g., hearing loss, tinnitus and hyperacusis) with attendant functional, societal and economical sequelae, including depression and dementia.[3] As the average age of nightclub attendees is young, the impact of hearing impairment can be lifelong.

In 2018, the World Health Organization (WHO) guidelines for the European Union recommended an average yearly loudness exposure of 70 dB LAeq (A-weighted, equivalent continuous sound level, in decibels) for all leisure noise sources combined.[4] Subsequently, in 2022 the WHO produced the ‘Global standard for safe listening venues & events’ guidance which provides standards and advice for patrons and venues.[1]

It comprises six ‘features’, five of which we perceive as relevant to the night clubber (the other one is specific to venue layout and design). These are sound level monitoring with an upper limit of 100 dB LAeq, 15 min sound level, personal hearing protection, the use of quiet zones and knowledge of the practical steps for safer listening.

Previous data collection tools have collected information on attitudes and behaviours of ‘patrons’ relevant to these five features; however, they all precede this standard and are not population-specific to the night clubber. Chung et al.[5] and Quintanilla-Dieck et al.[6] had 57% and 42.5% of respondents under 18 years old, respectively, whereas Beach[7] and Diviani et al.[8] used non-clubber specific respondents that were paid to complete online data collection tools. The sample sizes for these studies were 9693, 2500, 1000 and 1019, respectively. Further studies that exist within the literature include a small sample from a student population, qualitative studies and studies focusing on specific questions such as earplug use or attitudes towards loudness.[9,10,11]

Therefore, we wanted to design a population-specific and up-to-date data collection tool that evaluated how often clubbers attend loud music venues (as this will influence their safe noise dose) alongside their attitudes and use of safer listening practices, including personal hearing protection. We also wanted to find out if their visit frequency changed due to the development of hearing symptoms, as this could motivate stakeholders to better adopt the WHO’s six safe listening features.

MATERIALS AND METHODS

Ethics

Ethical approval was granted by St George’s University of London Ethics committee. Ethics rec number is 2023.0046.

Participants

Any English language-speaking person visiting the platform who was over 16 years in age.

Study design

A cross-sectional web-based data collection tool was designed in collaboration with the Research Design Service at the National Institute for Health and Care Research. This design was used due to its ability to rapidly and easily gather high-volume data.[12] Free-text, forced-response and Likert-scale items were used to collect responses. Barriers to earplug use were gathered from the pre-existing literature. The tool was tested for completion duration and ambiguity using five independent representative samplers. Feedback was gathered via individual interviews. Following this, question clarity, language, conciseness, answer choices, order and appropriate response collection were optimised.

Potential respondents were then exposed to our tool by Resident Advisor (RA), a globally leading online music magazine, ticketing site and community platform dedicated to showcasing electronic music, artists and events across the globe.[13] RA was chosen as it is culturally credible, has high engagement and is accessed by a large number of clubbers. This meant we could efficiently generate a large number of responses in a clubber-specific population. It also means we can effectively disseminate the findings of this study back to a clubber-specific population via RA channels, the cohort that may benefit most from the findings.

The electronic data collection tool Jotform (San Francisco, CA, USA) was hosted on the RA website and presented to English language users only and was active for a total of 7 hours. There was an incentive to win RA event tickets for participating.

Statistical analysis

As per the questionnaire-based study design, all variables in this analysis were categorical. After data pre-processing, there were 67 variables in the dataset, including unique ID, age category, social gender, country of origin and frequency and duration of clubbing. The variables for ear symptoms were whether respondents experienced ringing noises in their ears, muffled or reduced hearing or increased sensitivity to sounds − permanently or temporarily after going to a nightclub. The responses to these were divided into ‘Never’, ‘Sometimes’, ‘Often’ and ‘Always’. In addition to these, binary variables were created for each symptom type, whereby 1 corresponded to any of ‘Sometimes’, ‘Often’, ‘Always’ and 0 corresponded to ‘Never’. Furthermore, two overall symptom variables were created, one for the presence of any permanent symptom (scoring 1 on any of the three previous variables) and one for the presence of any temporary symptom. In tests of association between variables, only the respondents who did not have permanent ear symptoms were assessed for temporary symptoms, and only those who went clubbing at least sometimes were assessed for the duration of clubbing and protective hearing behaviours (taking regular listening breaks, moving to a quiet spot, checking noise levels, wearing earplugs and feeling that the noise was too loud).

Chi-square tests of independence were conducted for two-way cross-tabulation tables of categorical variables, except for when the expected counts for cells were below 5; in these cases, Fisher exact tests were conducted to assess independence. Counts and percentages were reported along with test statistics and P-values. Temporary ear symptoms were investigated for those who did not have permanent ear symptoms. Protective behaviours and concern for other nightlife issues were investigated in those who go out at least once a month. Logistic regression was conducted to investigate the association between age, frequency and duration of clubbing, concern for other nightlife issues, protective hearing behaviours and the presence of permanent ear symptoms. Odds ratios with corresponding 95% confidence intervals (CI) were reported.

Missing data were assumed to be missing at random and only complete cases were included in the analysis. Analyses were conducted in R, version 4.2.2 (Comprehensive R Archive Network; Vienna, Austria) and STATA, version 17 (StataCorp; College Station, TX, USA).

RESULTS

Respondent demographic

There were 1020 (29.0%) respondents from 3516 data collection tool invites. The majority of respondents were 26–30 years old (29.2%, n = 298), had a male social gender (63.8%, n = 651) and responded from the United Kingdom (43.7%, n = 446). Table 1 displays the demographic characteristics of respondents.

Table 1.

Participant characteristics

Age	n (%)
16–20 years	81 (7.9%)
21–25 years	213 (20.9%)
26–30 years	298 (29.2%)
31–35 years	170 (16.7%)
35+ years	258 (25.3%)
Social gender	n (%)
Man	651 (63.8%)
Woman	315 (30.9%)
Non-binary	27 (2.6%)
Transgender man	2 (0.2%)
Transgender woman	5 (0.5%)
Agender	5 (0.5%)
Prefer not say	15 (1.5%)
Country*	n (%)
UK	446 (43.7%)
USA	145 (14.2%)
Germany	128 (12.5%)
Spain	65 (6.4%)
Netherlands	34 (3.3%)
Canada	29 (2.8%)
Italy	23 (2.3%)
France	22 (2.2%)

^*Only countries with more than 20 responders are listed.

Respondent ear and hearing symptoms

In our sample, 73.4% (n = 749) of respondents had some degree (‘sometimes’, ‘often’ or ‘always’) of permanent ear symptoms and 26.6% (n = 271) did not [Table 2]. This distribution largely held for both men and women and all age groups, apart from those aged 16–20 years, for whom only 58.0% (n = 47) had some degree of permanent ear symptoms. In the cohort with no permanent ear symptoms, 61.3% (n = 166) had temporary ear symptoms and 38.7% (n = 105) did not; this was more prominent in those aged 21–25 years (73.7%, n = 42) and those aged 26–30 years (67.2%, n = 43), whereas for all other age groups, only about half had experienced temporary hearing symptoms. As with permanent hearing symptoms, the effect was the same across men and women.

Table 2.

Respondents current ear and hearing symptoms

Permanent hearing symptoms	Ringing in the ear or tinnitus	Muffled or reduced hearing	Increased sensitivity to sound	Any symptom
Never	444 (43.5%)	572 (56.1%)	519 (50.9%)	271 (26.6%)
Sometimes	466 (45.7%)	341 (33.4%)	348 (34.1%)
Often	72 (7.1%)	87 (8.5%)	126 (12.4%)	749 (73.4%)
Always	38 (3.7%)	20 (2.0%)	27 (2.6%)
Binary*	576 (56.5%)	448 (43.9%)	501 (49.1%)
Temporary hearing symptoms†	Ringing in the ear or tinnitus (n = 444)	Muffled or reduced hearing (n = 572)	Increased sensitivity to sounds (n = 519)	Any symptom (n = 271)
Never	178 (40.1%)	342 (59.8%)	408 (78.6%)	105 (38.7%)
Sometimes	221 (49.8%)	198 (34.6%)	103 (19.8%)
Often	40 (9.0%)	31 (5.4%)	8 (1.5%)	166 (61.3%)
Always	5 (1.1%)	1 (0.2%)	0
Binary*	266 (59.9%)	230 (40.2%)	111 (21.4%)

^*Binary represents those who have symptoms (sometimes, often, always) versus those that don’t (never). ^†Each category of temporary hearing symptoms excludes those with permanent hearing symptoms of the same category.

Less than 5% of respondents ‘always’ had tinnitus, hyperacusis or hearing loss. The breakdown of this is shown in Table 2. The majority of respondents had either permanent or temporary hearing symptoms of which tinnitus were the most commonly present noise-induced hearing loss symptom.

A logistic regression of the presence of permanent ear symptoms on age showed that age had a statistically significant effect at each increasing age grouping [Table 3]. For example, after adjusting for the reported frequency and duration of nightclubbing, 21–25 years old were twice as likely as 16–20 years old to report permanent symptoms of hearing damage (odds ratio [OR] 2.02 [95% CI 1.17–3.48]. This effect peaked for 26–30 years old (OR 2.77 [95% CI 1.63–4.71] before plateauing at an OR of 2. This suggests that the effect of loud noise exposure accumulates over time, with long-lasting damage to ear health.

Table 3.

Effect of age on the development of permanent hearing symptoms (n = 1020)

Age	n (%)	No ear symptoms n (%)	Ear symptomsn (%)	Odds ratios (ORs) of developing permanent hearing symptoms compared to 16–20 years old	P-value
16–20 years	81 (7.9%)	47 (6.3%)	34 (12.5%)	Reference
21–25 years	213 (20.9%)	156 (20.8%)	57 (21.0%)	OR 2.02 (95% CI 1.17–3.48)	0.012
26–30 years	298 (29.2%)	234 (31.2%)	64 (23.6%)	OR 2.77 (95% CI 1.63–4.71)	<0.001
31–35 years	170 (16.7%)	123 (16.4%)	47 (17.3%)	OR 2.05 (95% CI 1.16–3.61)	0.013
35+ years	258 (25.3%)	189 (25.2%)	69 (25.5%)	OR 2.06 (95% CI 1.21–3.52)	0.008

Respondents’ visit exposure

We asked respondents to report their average visit duration. This was to assess if respondents are exceeding the WHO’s sound-level limit, which is based on estimates of 2 hours exposure per month.[1,4,8] Respondents attended loud music venues 1–5 times per month (78.5%, n = 801) for a duration of 5–6 hours a visit (41.1%, n = 419) on average [Table 4]. Slightly more men (43.2%) than women (35.9%) stayed out 5–6 hours. 16–20 years old tended to go out slightly more often, with 24.7% (n = 20) going out 6–10 times per month compared to the overall average of 15.8% (n = 161). Overall, the hearing of the average respondent would not be protected by the WHO’s sound-level limit.

Table 4.

Visiting behaviours to loud music venues

Visit frequency, per month (n = 1020)	n (%)	No ear symptoms n (%)	Ear symptoms n (%)
0	27 (2.6%)	6 (22.2%)	21 (77.8%)
1–5	801 (78.5%)	228 (28.5%)	573 (71.5%)
6–10	161 (15.8%)	28 (17.4%)	133 (82.6%)
11–15	16 (1.6%)	4 (26.7%)	12 (73.3%)
15+	15 (1.5%)	5 (33.3%)	10 (66.7%)
Visit duration, hours (n = 1020)
1–2	21 (2.1%)	4 (19.1%)	17 (80.1%)
3–4	345 (33.8%)	89 (25.8%)	256 (74.2%)
5–6	419 (41.1%)	116 (27.7%)	303 (72.3%)
7–8	120 (11.8%)	41 (34.2%)	79 (65.8%)
8+	112 (11.0%)	20 (17.9%)	92 (82.1%)
Missing responses	3 (0.3%)	1 (0.1%)	2 (0.2%)

Respondents’ activity at loud music venues

We looked at the association between the presence of hearing symptoms and loud music venue exposure. Respondents with permanent ear symptoms attended nightclubs slightly less often (Fisher exact test, P = 0.046) but there was no association between permanent ear symptoms with the duration of time spent clubbing (Fisher exact test, P = 0.116). The presence of temporary ear symptoms was not associated with either the visit frequency (P = 0.521) or visit duration (P = 0.44) to loud music venues.

The presence of hearing symptoms or the worsening of symptoms would reduce the visit frequency to loud music venues except for patrons who already have permanent hearing symptoms.

Of those without any ear symptoms (n = 105), 3.8% said that, if they were to develop symptoms, they would go out more often, 30.5% said that it would not change how often they go out, and 65.7% said they would go out less often.

Of those who had temporary ear symptoms only (n = 166), 1.2% said that, if their symptoms worsened, they would go out more often, 46.4% said it would not change how often they go out, and 52.4% said they would go out less often.

Of those who had permanent ear symptoms (n = 749), 1.4% said they go out more often despite the symptoms, 65.9% said it has not changed how often they go out, and 32.7% said they go less often because of them.

An active focus on preserving the hearing health of patrons by promoters, venues and policymakers may help maintain patrons’ attendance at loud music venues.

Safer listening practices and attitudes

Respondents answered questions on safer listening practices. Twenty-eight-point-five percent (n = 291) of respondents took regular listening breaks, 5.9% of respondents (n = 60) checked the venue noise levels, 45.4% (n = 463) of respondents moved to a quieter spot, 32.3% (n = 329) of respondents wore ear plugs, 13.2% (n = 135) of respondents had a hearing test in the last year and 0.6% (n = 6) of respondents performed all practices. In addition, 74.7% (n = 762) of respondents did not feel that music venues are too loud. Figure 1 shows the distribution of these responses.

Figure 1.

Distribution of responses by protective behaviours.

The data collection tool asked questions about attitudes to earplugs on 5-point Likert scales. Sixty-point-five percent of respondents thought wearing earplugs was important (score 4 and 5). Forty-one-point-six percent thought earplugs were not fashionable (score 1 and 2), whereas 19.9% thought they were (score 4 and 5). Fifty-eight-point-five percent did not think it was easy to find earplugs at nightclubs (score 1 and 2), compared with 18.3% who thought it was easy (score 4 & 5), and 65.6% knew where to obtain them (score 3, 4 and 5).

Respondents were asked to rank comfort, social stigma, impact on music quality, availability and cost as barriers to wearing earplugs. Impact on music quality (45.0%) and comfort (28.0%) were ranked most often as the most important barriers to earplug use, whereas cost (30.8%) and stigma (49.2%) were ranked most often as the least important barriers. These preferences were the same for those who had worn earplugs and those who had not, except that those who had not worn earplugs placed more emphasis on social stigma than cost as an important barrier, compared with those who had worn ear plugs.

We also asked those respondents who had tried earplugs about their experience. Eight hundred thirty-three respondents (86.6%) had experience of wearing earplugs in the past. Of these, 305 (34.5%) respondents thought earplugs were uncomfortable (score 1 and 2), 311 (35.2%) thought they had a negative impact on their experience (score 1 and 2) and 357 (40.0%) thought they had a negative impact on the music quality (score 1 and 2).

To summarise the earplug data, approximately a third (33%) of respondents routinely wore earplugs, and the majority (60.5%) thought they were important. The main barrier to their use was their impact on music quality. Venues and promoters should promote earplugs of suitable quality, visible sound level monitoring, invest in improving venue acoustics and sound systems and provide access to quiet zones.[1] They should educate attendees through pre-event marketing materials and take venue-specific measures such as posters, which may help to increase these figures.

DISCUSSION

This study is a population-specific and up-to-date assessment of behaviours and attitudes of the music venue patrons.

Our visit data show evidence that the average clubber far exceeds their safe-noise dose, even in venues adhering to the WHO ‘safe’ sound level of 100 dB LAeq, 15 min. We found patrons to spend 5–6 hours, 1–5 times per month in these spaces. This is greater than the previous literature findings of between 2 and 4–5 hours per visit, respectively.[14,15]

Earplugs and other safer listening practices are, therefore, essential for the average night clubbers in order to avoid the development or progression of irreversible hearing damage and its sequelae of mental ill-health and dementia. However, we find that just a third of respondents wear earplugs despite 60% thinking they are important. This is particularly concerning as our population displayed a high percentage of permanent hearing damage symptoms.

We can conclude that there is a resistance to adopting safer listening practices despite visit behaviours that far exceed safe noise exposure estimates. Future efforts should focus on both highlighting the importance of these (and our data can inform this) as well as explaining how to overcome the barriers faced by patrons who know hearing protection is important but choose not to use them.

The most important obstacles we identified to the use of earplugs were the impact on music quality and comfort. It has previously been found that attitudes to earplug comfort and music quality improve with use and the type and quality of earplug used.[16] Our data also found that a minority of those who had tried earplugs before reported a negative impact on comfort (35%) and music quality (41%).

Not all earplugs are equal, with variations in the pattern and degree of attenuation and size and shape of insert, which can impact music quality and comfort. A period of trial and error may be required until a satisfactory experience is had with earplugs,[16] and this may account for the two-thirds of our cohort that did not use hearing protection despite the high prevalence of hearing symptoms. Promotion of safer listening practices, including overcoming barriers to earplug use, is vital to protect the hearing of clubbers in the context of their high-noise consumption.

The question for those of us interested in preserving hearing function in this population (and for those interested in not losing the attendance of this population at music events) is how should this information be promoted? Focusing on the United Kingdom, safer listening campaigns in nightclubs have historically been funded by charities with ‘Loud Music’ (Action on Hearing Loss, 2012)[23] and ‘Plug’em’ (Tinnitus UK, 2016).[17] But the efficacy of such campaigns is uncertain. Pleasingly, there has been a recent increase in industry-led campaigns with ‘Listen for Life’ (Night Time Industries Association, 2023),[18] ‘Don’t miss a beat’ (TicketSwap, 2023)[19] and ‘Tinnitus awareness series’ (Mixmag, 2024).[20] They have advantages over expert- or authority-centred campaigns that have been seen to provoke resistance to change in other contexts.[21] Industry is uniquely positioned to be relatable, credible and can cultivate safer listening practices as a normal part of nightlife culture. They can better promote the positive aspects of change, such as able to enjoy loud spaces for longer rather than the symptom burden and have direct access to night clubbers through their mailbox directories. We found that two-thirds of those clubbers without symptoms and half of those with temporary symptoms would attend music venues and events less often, if symptoms started. There are both social and financial incentives for DJs, venues and promoters to engage attendees in safer listening practices and improve the listening safety of venues in alignment with the ‘Global standard for safe listening venues & events’,[1] such as visible sound level monitoring, better venue acoustics and sound systems and access to quiet zones. We hope that these findings will fuel further industry-led initiatives.

Limitations

We recognise limitations relative to survey designs,[12] including sample selection bias and self-reporting errors but are reassured by our response rate. We also recognise difficulty in assigning cause to noise for the hearing symptoms reported by our respondents. However, we note a higher prevalence of temporary and permanent tinnitus (the most commonly reported symptoms) to the general population of 14%.[22] It is also possible that respondents with ear symptoms are more likely to respond to complete our data collection tool. The high percentage of respondents with permanent symptoms, who would not change their behaviours in the context of those with temporary or no symptoms who would, may suggest that people with permanent hearing symptoms who would change their behaviours may no longer be using RA to look for event tickets and music culture. Future studies could look at a narrower range for visit frequency, as well as focus on the most effective ways to introduce more positive hearing behaviours in this population.

CONCLUSION

Nightclub far exceed their safe noise dose and have a high burden of permanent hearing damage symptoms but still report resistance to adopting safer listening practices. They are less likely to continue attending these events, if their symptoms were to progress. The promotion of safer listening practices should focus on not only the importance of wearing earplugs but also to increase awareness of the barriers to their use, as well as venue specific improvements in acoustics and quiet space availability.

Ethical Approval

Ethical Approval was granted by St George’s university of London Ethics committee. Ethics rec number: 2023.0046.

Consent to Participate

All participants consented to their responses being used for research.

Author Contributions

JSB and CP originated the concept. JSB, PR and RK designed the manuscript. PB conducted the statistics. JSB and PB wrote the manuscript. JSB, PB, PR, CP, RK reviewed and edited the manuscript.

Availability of Data and Materials

Data are available on request.

Conflict of interest

There are no conflicts of interest.

Funding Statement

JSB received 400 pounds from ENT UK as part of a research award.